Abstract
BackgroundThe primary method of surveillance for the presence of SARS-CoV-2 is with nasopharyngeal swabs. Given the significant demand for nasopharyngeal swabs, a large number of previously untrained and unfamiliar staff are now performing this test. It was noted that there was significant heterogeneity in instructions for performing nasopharyngeal swabs in Canada, in contrast to the guidance provided by the Centers for Disease Control and Prevention (CDC), and the Pan American Health Organization (PAHO). The objective of this study was to review the instructions provided across Canada and contrast them to those of the CDC and PAHO.MethodsA standard series of steps for nasopharyngeal swab performance was outlined based on the CDC, PAHO, and New England Journal of Medicine instructions. A comprehensive search was performed in August 2020 to identify nasopharyngeal swab guidelines provided by public health in the provinces and territories of Canada. Regional health authority guidance was also collected. Instructions provided were contrasted against the standardized steps.ResultsInstructions were identified for all provinces and territories, and for 81 regional health authorities. From the provincial and territorial guidelines, 10/13 (77%) cleared the nasal passages before swab insertion, 11/13 (85%) tilted the patient’s head back slightly, 12/13 (92%) inserted the swab parallel to the palate, but only 3/13 (23%) inserted the swab to at least a depth of two-thirds the distance between the patient’s nose and ear. A clear majority (81%) of regional health authority guidelines followed their respective provincial guidelines.For depth of insertion, Quebec provided a pictogram but no distance or technique for estimation. Six provinces and territories - Northwest Territories, Nunavut, Ontario, Saskatchewan, Prince Edward Island and Alberta - recommended 4 cm or one-half the distance from nostrils to ear. British Columbia and Manitoba recommended a 7 cm depth of insertion. Nova Scotia recommended one-half to two-thirds the distance from nose to ear. Lastly, Newfoundland, New Brunswick and the Yukon recommended an insertion from nose to the external ear canal.ConclusionThere is significant heterogeneity in guidance for nasopharyngeal swab performance across Canada. The instructions provided by the majority of provinces and territories in Canada would not be effective in reaching the nasopharynx.Graphical abstract
Highlights
Initial reports of a novel coronavirus disease 2019 (COVID19) first came from Wuhan, Hubei Province of China in late December 2019 [1]
If the guideline document was not found for a regional health authority, the assumption was made that the provincial guideline was being used if one of the following criteria were met: i) the regional health authority COVID-19 resources referenced the provincial guideline for nasopharyngeal specimen collection
Aside from New Brunswick, no other provincial guideline referenced the Centers for Disease Control and Prevention (CDC), Pan American Health Organization (PAHO), or New England Journal of Medicine (NEJM) guideline, nor did any follow all steps outlined by the CDC, PAHO, or NEJM
Summary
Initial reports of a novel coronavirus disease 2019 (COVID19) first came from Wuhan, Hubei Province of China in late December 2019 [1]. The causative agent, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has since spread rapidly around the world, with over 34 million cases reported as of October 2020. Identifying acute infection with SARS-CoV-2 virus is carried out via nucleic acid amplification testing (such as real-time reverse transcriptase polymerase-chain reaction) and specimens are most often obtained from the respiratory tract [5, 6]. It was noted that there was significant heterogeneity in instructions for performing nasopharyngeal swabs in Canada, in contrast to the guidance provided by the Centers for Disease Control and Prevention (CDC), and the Pan American Health Organization (PAHO).
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Schedule a callMore From: Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale
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